Method of fixing surgical suture to tissue

ABSTRACT

A method of fixing surgical suture to tissue includes loading an anchor into a delivery guide and locating a fixation device outside of the delivery guide, with the anchor and the fixation device attached by a suture. The method includes providing an anchor deployment component coupled with the delivery guide and located proximal to the anchor, with a spring mechanism located between a distal portion of the anchor deployment component and the anchor. The method includes moving the anchor deployment component in a distal direction through the delivery guide, pushing the anchor out of the delivery guide, and delivering the anchor into tissue.

BACKGROUND

Intracorporeal suturing of tissue during surgery presents challenges tothe surgeon in that the surgeon is called upon to manipulate suturinginstruments within the confines of a relatively small incision formed inthe patient's body. In some cases, the surgeon is unable to see thesuture site. In such a case, the surgeon will digitally palpate with afinger to locate a landmark within the intracorporeal site, and thendeliver the suture at or near the landmark. Tying of the suture insidethe patient at the intracorporeal site can be challenging since thesurgeon is unable to see the site.

Improved suturing instruments and improved methods of delivering sutureswould be welcomed by the surgical staff.

SUMMARY

One aspect provides a surgical suture fixation system that includes adelivery guide, an anchor, a movable anchor deployment component and aspring mechanism provided between the delivery guide and the anchordeployment component. The delivery guide includes a conduit that guidesthe anchor deployment component. The conduit has a channel formedthrough at least a part of its sidewall. The anchor has a length ofsuture including a fixation device (or engagement slider) attached toit. The length of suture extends through the channel in the delivery andthe fixation device is provided externally of the delivery guide. Theanchor deployment component is configured to receive the anchor and todeliver the anchor into a tissue location. The system is adapted tofixing the suture to a tissue location with the anchor for supporting animplantable support material in a patient.

One aspect provides a method of fixing surgical suture to tissue. Themethod includes loading an anchor having a length of suture attachedthereto in an anchor deployment component. The method includesidentifying a tissue location on the sacrospinous ligament, the arcustendenius ligament or the periosteum covering the pubic bone with afinger. The method includes locating a delivery guide associated withthe anchor deployment component alongside the finger. The methodincludes delivering the anchor into the tissue location by moving theanchor deployment component through the delivery guide in a distaldirection. The method includes compressing a spring between the deliveryguide and the anchor deployment component.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings are included to provide a furtherunderstanding of embodiments and are incorporated in and constitute apart of this specification. The drawings illustrate embodiments andtogether with the description serve to explain principles ofembodiments. Other embodiments and many of the intended advantages ofembodiments will be readily appreciated as they become better understoodby reference to the following detailed description. The elements of thedrawings are not necessarily to scale relative to each other. Likereference numerals designate corresponding similar parts.

FIG. 1A is a perspective view of one embodiment of a surgical suturefixation system including an anchor that is insertable into an anchordeployment component.

FIG. 1B is a schematic partial cross-sectional view of the surgicalsuture fixation system illustrated in FIG. 1A.

FIG. 2A is a schematic side view of one embodiment of a surgical suturefixation system.

FIG. 2B is a schematic side view of one embodiment of a surgical suturefixation system.

FIG. 3A is a perspective view of one embodiment of the anchorillustrated in FIG. 1A.

FIG. 3B is an end view of the anchor.

FIG. 3C is a perspective view of one embodiment of an anchor.

FIG. 4 is a perspective view of an anchor outside of the anchordeployment component illustrated in FIG. 2A.

FIG. 5 is a perspective view of the anchor inserted into a lumen of theanchor deployment component illustrated in FIG. 4.

FIG. 6A is a perspective view of one embodiment of a surgical suturefixation system including a finger housing.

FIG. 6B is a partial cross-sectional view of one embodiment of asurgical suture fixation system including the finger housing illustratedin FIG. 6A.

FIG. 7A is a perspective view of one embodiment of a surgical suturefixation system including a finger housing and a cannula.

FIG. 7B is a partial cross-sectional view of the surgical suturefixation system illustrated in FIG. 7A.

FIG. 8 is a side view of one embodiment of a surgical suture fixationsystem showing the anchor deployment component inserted into a tissuelocation.

FIG. 9 is a perspective view of one embodiment of a surgical suturefixation system including a finger housing applied on a user's finger.

FIG. 10 is a block diagram of one embodiment of a method of fixingsurgical suture to tissue.

DETAILED DESCRIPTION

In the following Detailed Description, reference is made to theaccompanying drawings, which form a part hereof, and in which is shownby way of illustration specific embodiments in which the invention maybe practiced. In this regard, directional terminology, such as “top,”“bottom,” “front,” “back,” “leading,” “trailing,” etc., is used withreference to the orientation of the Figure(s) being described. Becausecomponents of embodiments can be positioned in a number of differentorientations, the directional terminology is used for purposes ofillustration and is in no way limiting. It is to be understood thatother embodiments may be utilized and structural or logical changes maybe made without departing from the scope of the present invention. Thefollowing detailed description, therefore, is not to be taken in alimiting sense, and the scope of the present invention is defined by theappended claims.

It is to be understood that the features of the various exemplaryembodiments described herein may be combined with each other, unlessspecifically noted otherwise.

Tissue includes soft tissue, which includes dermal tissue, sub-dermaltissue, ligaments, tendons, or membranes. As employed in thisspecification, the term “tissue” does not include bone.

The descriptors “proximal” and “distal” are taken relative to thesurgeon using the instrument. Thus, a distal direction is towards thetissue of the patient and a proximal direction is towards the surgeonand away from the tissue of the patient. A distal end is the furthestendmost location of a distal portion of a thing being described, whereasa proximal end is the nearest endmost location of a proximal portion ofthe thing being described.

Embodiments provide a surgical suture fixation system including ananchor deployment component useful to deliver an anchor to a tissuelocation inside the body of a patient. The anchor deployment componentis guided through a conduit of a delivery guide. At a first end, theanchor deployment component includes a cannula that allows placement ofan anchor at a tissue location deep within an incision site, which maybe out of the field of vision of the surgeon. At a second opposite endprovided outside the patient's body, the anchor deployment componentincludes a handle. The system is provided with a spring between theanchor deployment component and the delivery guide. When the second endof the anchor deployment component is pushed towards a tissue locationin the patient's body, the spring compresses to a loaded configurationwhile the cannula moves through the conduit and into the tissue todeliver the anchor. When the spring is released from its loaded state,the cannula ejects from the tissue location leaving the anchor in thedesired place. The system has a length of suture that is attached to theanchor and a fixation device attached to the suture. The suture extendsexterior to the patient and the fixation device extends outside of theanchor deployment component and delivery guide. The suture is availableto allow the surgeon to deliver a support along the suture from outsideof the patient to the anchor location inside the patient. The fixationdevice slides along the suture to fix the support at or near the anchorlocation inside the patient.

FIGS. 1A is a perspective view and FIG. 1B is a cross-sectional view ofone embodiment of a surgical suture fixation system 20 including adelivery guide 22, an anchor 24, a movable anchor deployment mechanism26 and a spring mechanism 28 (FIG. 1B).

The delivery guide 22 includes a conduit 30 having a distal end 32 and aproximal end 34. The conduit 30 of the delivery guide 22 includes anopening 36 in the distal end 32, an opening or passage 37 in theproximal end 34, and a channel 38 formed through the thickness of asidewall 39. The channel 38 extends from the distal end 32 of theconduit 30 partway to the proximal end 34 of the conduit 30. In oneembodiment, the channel 38 extends the entire distance between thedistal end 32 and the proximal end 34 of the conduit 30. In oneembodiment, the openings 36 and 37 in the distal and proximal ends 32and 34, respectively, are sized to provide passage for the movableanchor deployment component 26 to move proximally and distally throughthe openings 36, 37.

In one embodiment, the anchor 24 has a length of suture 40 attached toit through an eyelet 42 provided on the anchor 24. The anchor 24 isreceived by the movable anchor deployment component 26 located in theconduit 30 of the delivery guide 22 to be in a position ready forinsertion into tissue. In FIG. 1A, the length of suture 40 is shownexiting through the channel 38 of the delivery guide 22. In oneembodiment, the length of suture 40 includes an engagement slider 44 anda slip knot 46. FIG. 1A illustrates an anchor 24 shown outside of theanchor deployment component 26 and the delivery guide 22, at the end ofa phantom line extending from the distal end 32 of the conduit 30 of thedelivery guide 22. Also shown in phantom line is the length of suture 40attached to the anchor 24 through eyelet 42.

The movable anchor deployment component 26 includes a proximal portionhaving a proximal end 26 p and a distal portion having a distal end 26d. The anchor deployment component 26 defines a longitudinal extent “L”(FIG. 2A) between its proximal and distal ends 26 p, 26 d. In oneembodiment, the proximal portion of the anchor deployment component 26includes a first body section 26 a and the distal portion includes asecond body section 26 b (FIG. 1B). The first body section 26 a extendsfrom the proximal end 26 p into engagement with the delivery guide 22.The second body section 26 b is associated with the first body section26 a at a position lying inside the conduit 30 of the delivery guide 22.

FIG. 1B is a cross-sectional view of a distal portion of the surgicalsuture fixation system 20. FIG. 1B illustrates one embodiment whereinthe second body section 26 b of the movable anchor deployment component26 is configured to receive the anchor 24. The second body section 26 bincludes a rod 27 attached in the first body section 26 a of the anchordeployment component 26. The rod 27 extends through a channel formed inan internal wall 23 of the delivery guide 22. In one embodiment ananchor cup 29 is provided at a distal end of the rod 27 to receive andreleasably hold a proximal end of anchor 24. The anchor cup 29 holds theanchor 24 with a force, e.g. by a press fit provided by an innerdiameter Dcup of the anchor cup 29 being slightly less than an outerdiameter D (FIG. 3B) of the anchor. The force is adapted to besufficient to hold the anchor 24 in place until the anchor 24 isimplanted in the tissue, but less than a force required to pull theanchor 24 of out of the anchor cup 29 when the anchor is inserted into atissue location. Furthermore, a proximal surface, or anchor cup bottom29 a, is provided to push against a proximal end of the anchor 24 anddrive the anchor 24 into the tissue. The anchor cup 29 includessidewalls 29 b tapering distally towards an outer surface of the anchor24 to facilitate insertion into tissue.

A diameter Drod of rod 27 is relatively smaller than diameter Dfirst ofthe first body section 26 a of anchor deployment component 26. Thesizing of the rod 27 is selected to accommodate a spring mechanism 28provided between the anchor deployment component 26 and the deliveryguide 22. In one embodiment, the spring mechanism 28 includes a spring50 attached to the delivery guide 22 and a spring seat 52 provided onthe anchor deployment component 26. The spring 50 is attached to theinternal wall 23 of the delivery guide 22 and the spring seat 52 isprovided at a distal end of the first body section 26 a of the anchordeployment component 26. Other attachment positions of the spring andthe spring seat are acceptable. For example, in another embodiment, thespring 50 is attached to the distal end of the first body section 26 aof the anchor deployment component 26 and the spring seat 54 is providedon a proximal side of the internal wall 23 of the delivery guide 22. Thespring 50 and the spring seats 52, 54 are attached to the respectiveparts 22 or 23. The attachments can be done by any suitable meansincluding, but not restricted to, gluing, welding and casting. In oneembodiment, the spring seats 52, 54 include a metal sheet configured toprovide stabile support for the compression of the spring 50. The spring50 is shown in an uncompressed (or unloaded) configuration whereinneither the anchor 24 nor the anchor deployment component 26 extendsbeyond the distal end 22 d of the delivery guide 22.

FIG. 2A illustrates one embodiment of the surgical suture fixationsystem 20 wherein a distal portion 26 b of the anchor deploymentcomponent 26 includes a cannula 60. Apart from the cannula 60, the otherfeatures shown in FIG. 2A are similar to the described features of FIGS.1A-1B and have corresponding reference numbers. For illustrationpurposes, only an outline of the delivery guide 22 is shown in phantomline. The surgical suture fixation system 20 is suited for manualmanipulation by a surgeon. The surgical suture fixation system 20 issuited for use with robotic surgical systems where the device 20 isdelivered through a laparoscopic port to the tissue location inside thepatient.

The system 20 is shown with the spring 50 in an uncompressed state. Inone embodiment, a proximal end of cannula 60 is fixed/attached to thefirst body section 26 a of anchor deployment component 26. The anchor 24and the suture 40 are received in the cannula 60 of anchor deploymentcomponent 26 (indicated by dotted line). The cannula 60 includes apointed distal end 62 and an opening 64 sized to receive a body of theanchor 24. In one embodiment a slot 66 is formed through a wall of thecannula 60. The slot 66 provides an exit for the length of suture 40when the anchor 24 is loaded in the cannula 60 and also provides passagefor at least the eyelet 42 to extend outside of the cannula 60. Theanchor deployment component 26 defines a longitudinal extent L betweenits proximal end 26 p and its distal end 26 d at a distance from theproximal end 26 d. The distance of the longitudinal extent L is in arange of 3-15 inches, such as a longitudinal extent L from 4-12 inches,such as a longitudinal extent L from 5-9 inches, or a longitudinalextent L of about 7 inches.

FIG. 2B is a schematic side view of one embodiment of the surgicalsuture fixation system 20. The anchor deployment mechanism 26 has beenmoved in a distal direction indicated by arrow A by engaging the distalend 22 d of the delivery guide 22 (outlined in phantom line as in FIG.2A) against tissue and pushing the proximal end 26 p of the anchordeployment component 26 in the distal direction. An outer surface ofsection 26 a of the anchor deployment component 26 includes acriss-cross pattern to provide a no-slip or reduced slip surface for thesurgeon. Additionally or alternatively, an outer surface of the deliveryguide 22 includes an easily grippable surface.

When the anchor deployment component 26 is pushed in the distaldirection, the cannula moves beyond the distal end 22 d of the deliveryguide 22 and penetrates the tissue.

Movement of the distal end of the primary body 26 a toward the internalwall 23 of the delivery guide 22 compresses the spring 50, thusenclosing the compressed spring 50 between the primary body 26 a and theinternal wall 23. Releasing the compressed spring 50 will eject, ormove, the cannula 60 out of the tissue, leaving the anchor 24 in placein the tissue.

In one embodiment the spring mechanism 28 includes a spring holding pinand ratchet device configured to keep the spring in the compressedcondition without applying a continued pressure to the first bodysection 26 a. The spring holding device includes a controllable releasemechanism for releasing the spring from the compressed state, therebyretracting the cannula 60 from the tissue location. In someapplications, the pointed distal end 62 of the cannula 60 is sharp andneedle-like and is so configured to enter the periosteum tissue coveringa boney surface and glide under the periosteum tissue and over the bone.In this manner, the cannula 60 is configured to deliver the anchor 24(not shown) between the periosteum tissue and the bone.

FIG. 3A is a perspective view of one embodiment of the anchor 24 andFIG. 3B is an end view of the anchor 24. The anchor 24 includes multiplespines 47 extending from the body 44. In one embodiment, the spines 47project radially away from a center longitudinal axis A of the body 44,with each spine 47 shaped as a shark fin having a curved leading edge 70that meets with a curved trailing edge 72 at a point P. The curvedleading edge 70 is oriented to diverge away from the pointed leading end46 of the body 44 to allow the anchor 24 to glide into tissue andprevent the anchor from pulling out of the tissue. Although three spines47 and one eyelet 42 are illustrated, the anchor 24 is also suitablyprovided with a single spine 47 and one eyelet 42. The anchor 24 is alsosuitably provided with more than three spines 47.

The eyelet 42 projects radially away from the center longitudinal axis Aof the body 44 and as such is also configured to engage with tissue. Forexample, the eyelet 42 is provided with a height HE that issubstantially equal to the height of the spines 47 (the distance thatthe point P is away from the center axis A). The eyelet has a widthsubstantially equal to the width W of the spine 47.

The body 44 of the anchor 24 is substantially circular in lateralcross-section (FIG. 3B). The anchor 24 is configured to slide in anentry direction through the tissue, and is shaped to prevent withdrawalof the anchor 24 in the direction that is opposite of the entrydirection, i.e. a proximal direction. The curved leading edge 70 of theshark fin shape of the spines 47 facilitate the easy sliding of theanchor 24 through the tissue in the entry direction, and the curvedtrailing edge 72 of the spines 47 configure the anchor to resist beingpulled out of the tissue in the direction that is opposite of the entrydirection. In one embodiment, the body 44 of the anchor 24 has adiameter D, and the spine 34 has a width W that is less than about 25%of the diameter D (FIG. 3B).

FIG. 3C is a perspective view of one embodiment of an anchor 24′provided with an eyelet 42′that is disposed on the center longitudinalaxis A of the body 44. The spines 47 of the anchor 24′ are provided toengage with tissue, and the eyelet 42′ is streamlined to follow the body44 into the tissue channel that is formed when the anchor 24′ is driveninto the tissue by the anchor deployment component 26.

FIG. 4 is a perspective view of the anchor 24 positioned for insertioninto the cannula 60 of the anchor deployment component 26 and FIG. 5 isa perspective view of the anchor 24 inserted into the cannula 60. Thebody 44 of the anchor 24 is sized to slide into the opening 64 (alsocalled a lumen 64) of the cannula 60 with the spine 47 projecting out ofthe cannula 60. With reference to FIG. 4, the inside diameter of thelumen 64 of the cannula 60 provides a cannula diameter CD, and the spine47 has a height HS that is greater than the cannula diameter CD. Theheight HS of the spine 47 is at least 5% greater than the cannuladiameter CD. For example, the height HS of the spine 47 is in the rangeof 5-100% greater than the cannula diameter CD.

It is acceptable for the height HE (FIG. 3A) of the eyelet 42 to beequal to the height HS of the spine 47. It is also acceptable for theheight HE (FIG. 3A) of the eyelet 42 to be different from and not equalto the height HS of the spine 47.

The cannula 60 includes a tapered distal end portion 68 that tapers tothe pointed distal end 62, where the tapered distal end portion 68provides the cannula 60 with a needle-like point adapted for insertionthrough tissue.

The cannula 60 has a wall 80 that forms or defines the lumen 64 and aslot 82 formed through the wall 80. The slot 82 is proximal of thetapered distal end portion 68 and extends through the wall 80 tocommunicate with the lumen 64. The slot 82 includes a pair of opposedlongitudinal side edges 84 that extend from a proximal lateral edge 86in a distal direction to the distal end portion 68. The width of theslot between the longitudinal side edges 84 is sized to receive thewidth W of the spines 47. The cannula diameter CD is sized to receivethe diameter D (FIG. 3B) of the body 44 of the anchor 24.

With reference to FIG. 5, when the anchor 24 is loaded into the cannula60, the pointed leading end 46 of the body 44 is located proximal of thepointed distal end 62 of the cannula 40, and the spines 47 and theeyelet 42 extend outside of the cannula 60 and are positioned to engagewith tissue during implantation of the anchor 24. The proximal lateraledge 86 of the slot 82 is positioned to push against the eyelet 42 anddrive the anchor 24 into the tissue. The opposed longitudinal side edges84 of the slot 82 provide a stanchion that restrains the spines 47 andprevents the anchor 24 from rotating relative to the cannula 60. Thespines 47 and the eyelet 42 slide in a longitudinal direction relativeto the slot 82 to allow the cannula 60 to be removed from the tissuewhile leaving the anchor 24 implanted.

Suitable materials for fabricating the anchor 24 include plastics, ormetal, or sintered material. One suitable material for fabricating theanchor 24 is polypropylene. Another suitable material for fabricatingthe anchor 24 is a bioabsorbable polymer that configures the anchor 24to be absorbed into the body over a period of several weeks.

Suitable materials for fabricating the length of suture 40 includebio-inert components that do not bioabsorb, or bioabsorbable componentsthat are configured to be absorbed or resorbed by the body. One suitablematerial for fabricating the length of suture 40 is polypropylene. Othersuitable materials for fabricating the length of suture 40 includedissolvable sutures available from Ethicon™, a J&J Company located inSomerville, N.J., and include Monocryl™ (polyglycaprone 25) sutures,coated Vicryl™ (polyglactin 910) sutures, Ethicon Plus™ Sutures, orpolydioxanone sutures as examples.

Suitable materials for fabricating the cannula 60 and the anchordeployment component 26 include plastics or metal. One suitable materialfor fabricating the cannula 60 is stainless steel. One suitable materialfor fabricating the anchor deployment component is Nitinol, a metalalloy of nickel and titanium. Other suitable materials are acceptable.

FIG. 6A is a perspective view and FIG. 6B a partial cross-sectional viewof one embodiment of a surgical suture fixation system 20′ including adelivery guide 22′, an anchor 24, a movable anchor deployment component26′ and a spring mechanism 28. Surgical suture fixation system 20′ alsoincludes a finger housing 100 coupled to the delivery guide 22′.

The delivery guide 22′ includes a conduit 30′ having a distal end 32′and a proximal end 34′. The conduit 30′ of the delivery guide 22′includes openings 36′ and 37′ in the distal and proximal ends 32′, 34′respectively, and a channel 38′ formed through a sidewall 39′ for someof the length of the conduit 30′. In one embodiment, the channel 38′extends from the distal end 32′ of the conduit 30′ and at least a partof the distance to the proximal end 34′ of the conduit 30′. In oneembodiment, the openings 36′ and 37′ in the distal and proximal ends32′, 34′ are sized to provide passage for the movable anchor deploymentcomponent 26′ to move proximally and distally through the openings 36′,37′.

In one embodiment, the movable anchor deployment component 26′ includesan elongated stick element 26 e′ extending between a proximal end 26 p′and a distal end 26 d′, the distal end 26 d′ engaging into the deliveryguide 22′ through the opening 37′ in the conduit 30′. In one embodiment,the distal end 26 d′ of the anchor deployment component 26′. The stickelement 26 e′ extends from proximal end 26 p′ into engagement with thedelivery guide 22′ through opening 37′ in the proximal end 34′ of theconduit 30′ where its distal end 26 d′ receives anchor 24. In oneembodiment, the stick element 26 e′ is a rigid wire like componenthaving a significantly higher resistance to bending than a tubing 31′enclosing the element 26 e′. In one embodiment, the tubing 31′ isconfigured to be attached to the delivery guide 22′ around a proximalportion 30 p′ of the conduit 30′. In some configurations, the proximalportion 30 p′ includes a proximally tapering section and defines a ledgea distal end of the tapering section, the proximal portion 30 p′configured to receive and hold one end of the tubing 31′. In anotherembodiment, the tubing 31′ and the conduit 30′ are monolithicallyassociated.

In some applications, conduit 30′ of the delivery guide 22′ and tubing31′ in total encloses between 10-100% of the longitudinal extent L ofthe anchor deployment component 26′. For example, the proximal end 26 p′of the anchor deployment component 26′ is configured to extend “out ofthe tubing 31” to provide for manual manipulation of the proximal end 26p′ (FIG. 6B).

In one embodiment, the anchor 24 has a length of suture 40 attached toit through an eyelet 42 provided on the anchor 24. The anchor 24 isreceived by the movable anchor deployment component 26′ located in theconduit 30′ of the delivery guide 22′ to be in a position ready forinsertion into tissue. A length of suture 40′ is shown exiting throughthe channel 38′ of the delivery guide 22. In one embodiment, the lengthof suture 40 includes an engagement slider 44 and a slip knot 46.

The finger housing 100 is attachable to (or on) a finger F of a person,such as a practitioner. The finger housing 100 is configured to leave atleast a distal tip of the finger F available to palpate tissue andidentify a desired (or target) tissue location. In one embodiment, thefinger housing 100 includes a through-going opening 102 defined by apair of opposing longitudinal edges 104. The opening providesflexibility to the finger housing including accommodation of differentfinger sizes. In one embodiment, the finger housing 100 is coupled tothe delivery guide 22′ as a separate component attached by gluing orotherwise mechanically connected to the delivery guide. In anotherembodiment the finger housing 100 is monolithically associated with thedelivery guide 22′. For example, the finger housing 100 and the deliveryguide 22′ can be integrally cast or injection molded. The finger housing100 and the delivery guide 22′ are coupled to each other adjacent adistal portion of the anchor deployment mechanism 26′.

A spring mechanism 28′ is provided between the anchor deploymentcomponent 26′ and the delivery guide 22′ as it is schematicallyillustrated in FIG. 6B. In one embodiment, the spring mechanism 28′includes a spring 50′ attached to an internal wall 23′ of the deliveryguide 22′ and a spring seat 52′ provided on the anchor deploymentcomponent 26′. The anchor 24 is shown inserted in the distal end of asecond body section 26 b′ of the movable anchor deployment component26′. Second body section 26 b′ is configured as an elongated section ofstick element 26 e′. The elongate section extends through an opening inan internal wall 23′ of the delivery guide 22′. In one embodiment ananchor cup 29′ is provided at a distal end of the elongated section ofstick element 26 e′ to receive and releasably hold a proximal end of ananchor 24 inserted therein. Anchor 24 includes an anchor of one thetypes illustrated in FIG. 3A-3C and is provided and received in theanchor cup 29′. In one embodiment, the eyelet 42 extends through thechannel 38′ in the sidewall 39′ of the conduit 30′ while fins 47 of theanchor 24 extend at least partly through the channel 38′ and are justvisible in FIG. 6. For further description on the features of FIG. 6Band their interactions, please see the specification's description ofthe corresponding features of FIG. 1B.

FIG. 7A is a perspective view of one embodiment of the surgical suturefixation system 20′ including finger housing 100 with the distal end 26d′ of the anchor deployment component 26′ including a cannula 60′ forreceiving an anchor 24. In one embodiment, the cannula 60′ is configuredas an elongated section of the anchor deployment component 26′. Inanother embodiment, the cannula 60′ is provided as a separate elementcoupled to the distal end 26 d′ of the anchor deployment component 26′.

The cannula 60′ includes a tapered distal end portion 68′ that tapers tothe pointed distal end 62′, where the tapered distal end portion 68′provides the cannula 60′ with a needle-like point adapted for insertionthrough tissue. The cannula 60′ also includes a slot 66′. For furtherdescription on cannula 60′, please see the specification's descriptionof the corresponding features of FIG. 4.

The anchor 24 includes an anchor of the types illustrated in FIG. 3A-3Cand is provided and received in the cannula 60′. In one embodiment, theeyelet 42 and the fins 47 only extend through the slot 66′ in thecannula 60′, but not through the channel 38′. In another embodiment,eyelet 42 and fins 47 of the anchor 24 extend through both the slot 66′in the cannula 60′ and at least partly through channel 38′ of theconduit 30′ of the delivery guide 22′ (not illustrated). FIG. 7 alsoillustrates the length of suture 40 exiting through the slot 66′ and thechannel 38′ and having engagement slider 44 and slip knot 46 providedthereon externally of the delivery guide 22′. The anchor 24 is sized andshaped to go into soft tissue and slide along bone, such as, but notlimited to, going into the periosteum tissue along the pubic bone.

FIG. 7B is a schematic and partial cross-sectional view of a distalportion of the surgical suture fixation system 20′ illustrated in FIG.7A. The spring 50 is provided between the delivery guide 22′ and aspring seat 52′ on the anchor deployment component 26′. The spring 50′is shown in an uncompressed state and the cannula 60′ including theanchor 24 has not moved distally out of the conduit 30′ of the deliveryguide 22′. The anchor 24 including pointed leading end 46 positionedproximal to pointed distal end 62′ of the cannula 60′, eyelet 42 andfins 47, is partly visible through both channel 38′ of the conduit 30′and slot 66′ of the cannula 60′. As mentioned above, the eyelet 42 andthe fins 47 extend through at least the slot 66′ of the cannula 60′ andin embodiments also through the channel 38′ in the conduit 30′. Eyelet42 and fins 47 extend radially away from central axis A (FIG. 3A) of thecannula 60′, i.e. out of the plane of the paper towards the reader.

FIG. 8 is a schematic and partial cross-sectional view of the distalportion of the surgical suture fixation system 20′ employed to place theanchor 24 into tissue. The anchor deployment mechanism 26′ has beenmoved in a distal direction indicated by arrow A into a tissue locationby pushing the proximal end 26 p′ of the anchor deployment component 26′out of tubing 31′. The anchor deployment component 26′ includes a grip26 f′ or a flange 26 f′ near the proximal end 26 p′. By moving theanchor deployment component 26′ distally, the cannula 60′ extends outand beyond the distal end 22 d′ of the delivery guide 22′ to penetrateand enter into the tissue location. As described in more detail withreference to FIGS. 3A-3C, the curved leading edge 70 of the shark finshape of the spines 47 of the anchor 24 facilitate easy sliding of theanchor 24 through the tissue in the entry direction, and the curvedtrailing edge 72 of the spines 47 configure the anchor 24 to resistbeing pulled out of the tissue in the direction that is opposite of theentry direction. The distal movement of the anchor deployment component26′ compresses the spring 50 because the spring seat 52′ is coupled tothe anchor deployment component 26′ and thus also moves in the distaldirection. This movement encloses the compressed spring 50 between thespring seat 52′ and the internal wall 23′.

FIG. 9 is a perspective view of one embodiment of the system 20′including the finger housing 100. The finger housing 100 is mounted orapplied to a finger F of a practitioner. A distal tip of thepractitioner's finger F is shown contacting a tissue location includinga location on the periosteum tissue covering the pubic bone PB, on thesacrospinous ligament or on the arcus tendenius ligament. In oneembodiment, the anchor deployment component 26′ includes a first bodysection 26 a′ at least partly enclosed in tubing 31′, the tubing 31′including a material and dimensions with less resistance to bending thanthe anchor deployment component 26′. The distal end 26 d′ of the anchordeployment component 26′ includes cannula 60′ and is shown in a positionin which it has been moved distally out of the conduit 30′ of thedelivery guide 22′ and into a tissue location. Anchor 24 is shown in itsposition received in the cannula 60′. The system 20′ is in a positionwhere the anchor 24 is delivered to a desired tissue location, and wherethe anchor deployment component 26′ has not yet been moved proximallyout of the tissue. In this position, the spring 50 of the springmechanism (FIG. 8B) is in a compressed state. In one embodiment, whenthe anchor deployment component 26′ is moved in the proximal direction,the spring 50 is released from its compressed state and the cannula 60′is withdrawn from the tissue location leaving the anchor 24 fastened inthe tissue location. The release of the spring 50 of the springmechanism causes the cannula 60′ to eject from the tissue location in aquick movement with little or no physical force required by the surgeonto move the cannula in the proximal direction. This makes the retractionof the cannula easier and controls the retraction path of the cannulaback through the tissue canal established by the initial insertion ofthe cannula. In some applications, the proximal end 26 p′ of the anchordeployment component 26′ is provided at a distance from the distal end26 d′ (FIG. 2A). This allows manual engagement of the proximal end 26 p′to take place in a position clear of other tissue, such as outside apatient's body. FIG. 9 also schematically illustrates a porous supportmaterial 110 to be implanted in a patient, a part of which is engaged bythe length of suture being 40 fastened in the tissue location by anchor24.

One embodiment of the system 20′ illustrated in FIG. 9 includes anengagement slider 44 that is attached to the suture 40, where theengagement slider 44 is configured to slide along the suture 40 anddirect the support 110 into the patient's body and against the tissue.In one embodiment, the engagement slider 44 has a first orifice 92 and asecond orifice 94. An anchor 24 is engaged with tissue, e.g. theperiosteum tissue of the pubic bone or a ligament, and a first end 49 aof the suture 40 extends from the anchor 24 through the first orifice92, and a second end 49 b of the suture 40 extends through the secondorifice 94 and defines a slip knot 46 together with the first end 49 aof the suture. The slip knot 46 (or alternatively another terminationdevice) is provided to tie the suture 40 against the engagement slider44 after the engagement slider 44 and the support 110 has been deliveredto the pubic bone or ligament. The engagement slider 44 is locatedbetween the anchor 24 and the slip knot 46. The engagement slider 44slides along the suture 40 and is operable to push or otherwise deliverthe support 110 against the pubic bone or ligament.

Suitable materials for fabricating the support 110 include porousmaterials that allow tissue ingrowth throughout the support structure toanchor the support 110 in the body after implantation and healing.Suitable such porous materials include autograft material (the patient'sown tissue), allograft material (tissue from a cadaver), xenograftmaterial (tissue from another species), or synthetic materials such aswoven fabrics, meshes, nonwoven fabrics, meshes, fibrillated fibers, orspun and fibrillated fibers that are provided with voids (pores)configured to allow tissue ingrowth into the support 110. The pores aregenerally larger, on average, than 75 μm.

Suitable materials for fabricating the finger housing 100 includeplastics or metal. One suitable material for fabricating the fingerhousing 100 is polyethylene. Other suitable materials are acceptable.

Suitable materials for fabricating the anchor deployment component 26′include plastics or metal. One suitable material for fabricating theanchor deployment component 26′ is Nitinol, a metal alloy of nickel andtitanium. Other suitable materials are acceptable.

Suitable materials for fabricating the tubing 31′ include plastics ormetal. One suitable material for fabricating the tubing 31′ ispolyurethane. Other suitable materials are acceptable.

Suitable materials for fabricating the engagement slider 44 includeplastics or metal. One suitable material for fabricating the engagementslider 44 includes polypropylene. Another suitable material forfabricating the engagement slider 44 includes stainless steel. In oneembodiment, the engagement slider 44 is fabricated to be bioabsorbable.

In an aspect, the application relates to a method of fixing surgicalsuture to tissue.

FIG. 10 is a block diagram 120 of one embodiment of a method of fixingsurgical suture to tissue. The method includes at 122 loading an anchorhaving a length of suture attached thereto in an anchor deploymentcomponent 26, 26′. The method includes at 124 identifying a tissuelocation on the sacrospinous ligament, the arcus tendenius ligament orthe periosteum with a finger. The method of fixing surgical suture totissue includes at 126 locating a delivery guide 22, 22′ associated withthe anchor deployment component 26, 26′ alongside the finger. The methodincludes at 128 moving the anchor deployment component 26, 26′ in adistal direction to deliver the anchor 24 in the tissue location andcompressing a spring 50 between the delivery guide 22, 22′ and theanchor deployment component 26, 26′.

With additional reference to FIGS. 2A, 2B, 8 and 9, a surgical suturefixation system 20, 20′ including a length of surgical suture 40 isprovided for attaching the suture to a desired tissue location in apatient in an intracorporeal suturing procedure. The length of suture isattached to the anchor 24. The suture is configured to extend through asupport material 110, the support material 110 including a poroussupport or mesh type support material for supporting internal organs ortissues. The anchor 24 is useful for fixating the support material 110within the patient's body. The system 20, 20′ is sized to be able todeploy the anchor 24 through a single incision and into the periosteumtissue that covers the pubic bone or to a ligament, particularlyincluding the sacrospinous and arcus tendenius ligaments.

EXAMPLE

The following example illustrates, with particular reference to FIGS.2A-2B and FIGS. 8 and 9, the fixation of surgical suture using thesystem described above.

The patient is prepared for the relevant type of surgery, such as, butnot limited to, sacropolpopexy surgery in a female patient. The patientis positioned on a surgical operating table in a lithotomy, or modifiedlithotomy position, and is anesthetized.

The surgeon makes an incision in the pelvic region of the patient. Oneacceptable incision approach is a single incision approach including theformation of a single (exactly one) incision in the anterior wall of thevagina (e.g., an upper wall of the vagina with the patient in thelithotomy position). Tissue is dissected lateral and distal the incisionto access the supporting ligaments and other tissue in the pelvis.

The anchor 24 is driven through the material of the support 110 prior toor subsequent to loading the anchor 24 in the anchor deploymentcomponent 26. The fixation device 44 is arranged outside of the anchordeployment component 26 and the delivery guide 22. The suture isattached to the anchor.

The delivery guide 22 is placed near, or alongside, the distal tip of afinger of the surgeon. The surgeon inserts the finger and the distalportion of the surgical suture fixation system through the incision toreach a tissue location inside the pelvic region of the patient. Thesurgeon palpates the tissue with the distal tip of the finger toidentify the desired tissue location for placement of the anchor 24.Typically, the surgeon palpates for this location since it is notvisible through the incision.

The proximal end of the anchor deployment component 26 is then pushed inthe distal direction by the thumb of the hand that has palpated thetissue location or by the other hand, depending upon the surgeon'spreference. The distally-directed force operates to translate and insertthe cannula 60 of the distal portion of the anchor deployment component26 (that has been loaded with the anchor 24) into the tissue location.Pushing the anchor deployment component 26 in the distal directioncompresses the spring 50 of the spring mechanism of the system.

The anchor deployment component has a length such that its proximal endis located visibly outside the incision in the patient's body and isengaged to release the compressed spring. Releasing the spring from itscompressed state forces the anchor deployment component to move in theproximal direction, which ejects and retracts the cannula from thetissue location. As a consequence, the anchor is fastened in the tissuelocation while the surgeon still has her/his finger tip located at thetissue location. The fixation device 44 is slid along the suture 40 anddirects the support 110 into the patient's body and against the tissue.

Some surgical suture fixation systems do not allow the practitioner todeliver the suture without having to move the tip of the palpatingfinger located on the identified tissue location.

The surgical suture fixation system presented herein provides a systemthat gives the surgeon the option to palpate and identify a desiredtissue location while simultaneously providing the anchor and suture inthe desired tissue location without having to move her/his finger orapply a separate device to fasten the suture to the tissue. This makesit possible to load and insert the anchor attached with the suture, thesupport and the fixation device into the identified tissue location aspart of the same procedure thereby avoiding the need to re-identify atissue location and to use more than one surgical tool or device tofasten the suture to the tissue. The surgical suture fixation systemprovides for intracorporeal suturing with the suture line convenientlyavailable outside of the patient's body.

Although specific embodiments have been illustrated and describedherein, it will be appreciated by those of ordinary skill in the artthat a variety of alternate and/or equivalent implementations may besubstituted for the specific embodiments shown and described withoutdeparting from the scope of the present invention. This application isintended to cover any adaptations or variations of medical devices asdiscussed herein. Therefore, it is intended that this invention belimited only by the claims and the equivalents thereof.

What is claimed is:
 1. A method of fixing surgical suture to tissue, themethod comprising: loading an anchor into a delivery guide; locating afixation device outside of the delivery guide, with the anchor and thefixation device attached by a suture; providing an anchor deploymentcomponent coupled with the delivery guide and located proximal to theanchor, with a spring mechanism located between a distal portion of theanchor deployment component and the anchor; and moving the anchordeployment component in a distal direction through the delivery guide,pushing the anchor out of the delivery guide, and delivering the anchorinto tissue.
 2. The method according to claim 1, further comprising:engaging a support material with the suture and locating the supportmaterial between the anchor and the fixation device.
 3. The methodaccording to claim 1, further comprising: engaging a support materialwith the suture and locating the support material between the anchor andthe fixation device; and sliding the fixation device along the sutureand forcing the support material into contact with the tissue.
 4. Themethod according to claim 1, further comprising: engaging a supportmaterial with the suture and locating the support material between theanchor and the fixation device; and delivering the support materialalong the suture from outside of a patient to the anchor located insidethe patient.
 5. The method according to claim 1, further comprising:engaging a porous support material with the suture; and delivering theporous support material along the suture from outside of a patient tothe anchor located inside the patient.
 6. The method according to claim1, further comprising: engaging a support material with the suture;delivering the support material along the suture from outside of apatient to the anchor located inside the patient; and supporting anorgan of the patient with the support material.
 7. The method accordingto claim 1, further comprising: creating an incision in a vagina of apatient; inserting the delivery guide and the anchor into the incision;engaging a support material with the suture; delivering the supportmaterial along the suture through the incision and into the patient; andsupporting an organ of the patient with the support material.
 8. Themethod according to claim 1, further comprising: creating exactly oneincision in a vagina of a patient; inserting the delivery guide and theanchor into the incision; engaging a support material with the suture;delivering the support material along the suture through the incisionand into the patient; and supporting an organ of the patient with thesupport material.
 9. The method according to claim 1, comprising loadingthe anchor into a conduit of the delivery guide, with the conduit havingan opening in a distal end and a channel formed in a sidewall of theconduit, with a portion of the anchor extending out of the conduit andthrough the channel.
 10. The method according to claim 1, comprisingloading the anchor into a conduit of the delivery guide, with theconduit having an opening in a distal end and a channel formed in asidewall of the conduit, with an eyelet of the anchor extending out ofthe conduit and through the channel and the suture engaged with theeyelet of the anchor.
 11. The method according to claim 1, comprisingloading the anchor into a conduit of the delivery guide, with the anchorhaving a body including a pointed leading end that is configured topierce the tissue, a spine projecting radially away from the body andhaving a width and a height configured to allow the spine to engage withthe tissue, with the eyelet attached to a trailing end of the body. 12.The method according to claim 1, comprising loading the anchor into aconduit of the delivery guide, with the anchor having a body including apointed leading end that is configured to pierce the tissue and a spineprojecting radially away from the body, with the spine providing theanchor with a plurality of teeth.
 13. A method of fixing surgical sutureto tissue and supporting an organ in a patient, the method comprising:creating an incision in a vagina of a patient; loading an anchor into adelivery guide; locating a fixation device outside of the deliveryguide, with the anchor and the fixation device attached by a suture;engaging a porous support material with the suture; providing an anchordeployment component coupled with the delivery guide and locatedproximal to the anchor, with a spring mechanism located between a distalportion of the anchor deployment component and the anchor; inserting thedelivery guide and the anchor into the incision; moving the anchordeployment component in a distal direction through the delivery guide,pushing the anchor out of the delivery guide, and delivering the anchorinto tissue; delivering the support material along the suture throughthe incision and into the patient; sliding the fixation device along thesuture and fixating the support material relative to the tissue with thefixation device; and supporting a prolapsed organ of the patient withthe support material.
 14. The method of claim 13, comprising deliveringthe anchor into periosteum tissue.